Fibroids are benign growths in the uterus which can be tiny or very large. They are often multiple, and result in enlargement and distortion of the uterus. They are quite common. There are 4 types:

• Submucosal (on the inside of the uterus)
• Subserosal (on the outside of the uterus)
• Intramural (inside the muscle wall of the uterus)
• Pedunculated (grows with a stalk attachment to the uterus)

Some women with fibroids have no symptoms at all. For others, fibroids can cause heavy menstrual bleeding, difficulty getting pregnant, risks during pregnancy, pelvic pain, or bladder and bowel pressure symptoms. Vary rarely they can become cancerous.

Myomectomy is an operation to remove fibroids. It leaves the uterus intact and therefore is suitable for women planning to have children or wanting to retain their uterus. Myomectomy can be performed as:

• An open abdominal procedure
• A laparoscopic (keyhole) myomectomy
• A hysteroscopic myomectomy (where there is no abdominal cut and the fibroid is removed through the vagina via hysteroscopic surgery).

Hysterectomy completely removes the uterus and all fibroids and therefore is definitive treatment.

Dr Marshall now performs most myomectomies by keyhole, laparascopic or hysteroscopic surgery. As a sub-specialist in advanced hysteroscopic surgery, he also teaches other gynaecologists in hysteroscopic resection of fibroids.